Company Name:

Advanced Health

Location:

Coos Bay, Oregon

Approximate Salary:

Commensurate with Experience

Job Category:

Chiefs/Directors/Department Heads

Work Setting:

Business/Industry

Position Type:

Full Time

Required Experience:

5 - 10 years

Required Education:

Master's Degree

Date Posted:

May 25, 2019

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Director of Coordinated Care (LMHP - Clinical Psychologist, Psych NP, Clinical Social Worker)

This position is the licensed mental health professional (LMHP) who is primarily responsible for the management and oversight of the Intensive Care Coordination and Exceptional Needs Care Coordination (ICC/ENCC) Services program for eligible Advanced Health members. The ICC/ENCC Services program provides a diverse system of integrated care coordination teams and comprehensive treatment and support services to over 20,000 Medicaid beneficiaries that have physical, social, emotional, behavioral, and financial needs that cannot be addressed through Primary Care Case Management (PCMM). The Executive Care Coordination Director is responsible for the overall operating functions, including vision setting and direction for the coordinated care operations and adherence to contract requirements.
Share responsibility for achieving the Quadruple Aim of health care reform: member engagement and satisfaction, improving quality of care, managing costs, and honoring diversity and equity by focusing on the "member" by "doing what is right" and "thinking." All duties are performed in compliance with organization’s policies and procedure, contractual obligations, and within federal and state laws and guideline including HIPAA, OSHA, and Waste Fraud and Abuse regulations. Protect the dignity, privacy and confidentiality of members and their families, as well as co-workers and others.
Strategy, Vision, and Leadership
1. In partnership with the Executive Team and managers, advance the organization’s culture of “it’s about the member, doing what is right, and thinking”
2. Maintain continuous lines of communication with the Executive Team, managers and all assigned staff
3. Identify critical issues that require the attention of the Chief Executive Officer, and make recommendations for addressing and/or resolving these issues
4. Develop thought leadership around specific topics and emerging practice areas
5. Share in knowledge dissemination, reporting, and communications
6. Contribute to the development and attainment of the organization’s strategic objectives

ESSENTIAL RESPONSIBILITIES: Program Development

  1. Read, mark, learn, and thoroughly comprehend care coordination health elements of Advanced Health’s complex contractual agreement with the Oregon Health Authority, for the services of a Coordinated Care Organization; translate that contract into a model integrated coordinated care system
  2. Responsible for the leadership and knowledge management in developing, implementing, and continuously improving the organization’s care coordination program through collaboration with leadership and Executive Team
  3. Direct and manage Advanced Health’s ICC/ENCC Services Program: establish program and monitoring standards and measures; monitor care coordinators and provider adherence to PCCM and ICC/ENCC Service guidelines; facilitate operational problem solving and decision-making; monitor plan quality improvement activities
  4. Create, implement and revise policies and procedures that ensure a system for the coordination of care and the arrangement, tracking and documentation of all Referrals and Prior Authorizations to other Providers
  5. Follow ICC/ENCC standards and Care Coordination standards, including transition meetings
  6. Regularly and consistently communicate policies and procedures to providers, regularly monitor Providers’ compliance and take corrective action when necessary to ensure provider compliance
  7. Develop policies and procedures which relate to the organization, management and treatment systems of the program
  8. Establishes priorities, schedules tasks completion and meets scheduled deadlines as evidenced by timeliness of reports
  9. Develop procedures for evaluating the effectiveness of the program's treatment process to assure the program goals and objectives, patient needs and compliance with all applicable quality standards as well as federal, state and local requirements, codes and regulations are being met
  10. Responsible to determine benchmarks, goals and outcomes for ICC/ENCC programs as well as high cost, volume and risk conditions
  11. In collaboration with the Executive Program Director, coordinate agreements with appropriate community agencies and programs that will ensure continuity of care and the proper use of community resources
  12. Ensures the timely completion of all ICC/ENCC contract deliverables
  13. Provides leadership and direction in the development of appropriate risk management strategies
  14. Participates in all required meetings
  15. Ensures collaboration and coordination with all stakeholders
  16. Serves as the organization’s official ICC/ENCC representative within the community
  17. Ensure compliance with SWOIPA policies and procedures as applicable to area(s) of responsibility
  18. Handle confidential information and materials appropriately and maintains a secure work area
  19. Other duties as assigned

ESSENTIAL RESPONSIBILITIES: Program & LMHP Oversight

  • Provides clinical oversight of all ICC/ENCC activities ensuring of high quality, consistent service that result in optimum outcomes for members
  • Analyze membership, enrollment and utilization data to identify populations within membership that would benefit from focused ICC/ENCC management programs
  • Monitor and evaluate the efficiency and effectiveness of ICC/ENCC activities through analysis and use of relevant data and management reports
  • Complete monthly review of ICC/ENCC cases assigned to care coordinators to include required items per contractual agreement

ESSENTIAL RESPONSIBILITIES: Quality Improvement

  • Coordinate with Quality Department to ensure understanding of State required Performance Improvement Projects and outcome measures
  • Assist Director of Quality and Medical Director in identifying providers with practice patterns which are not in conformity to best practice standards
  • Participate in quality and organizational process improvement activities and teams when requested
  • Lead person for audit preparation when focus is care coordination programs and services

ESSENTIAL RESPONSIBILITIES: Communication & Teamwork

  • Openly, clearly and respectfully share and receive information, opinions, concerns and feedback in a supportive manner
  • Work collaboratively by mentoring new and existing co-workers, building bridges and creating rapport with team members across the organization
  • Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
  • Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
  • Detail oriented and strive for accuracy in all functions of the ICC/ENCC Service processes

ESSENTIAL RESPONSIBILITIES: Professional Development

  • Remain current with care coordination best practice standards
  • Recognize new developments in coordinated care and healthcare practice and anticipate organizational modifications
  • Keep up-to-date on emerging trends in the delivery of care coordination, as well as professional development opportunities that align with individual goals related to the position
  • Advance personal knowledge base by pursuing continuing education in order to enhance professional competence
  • Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
  • Expansion of knowledge, skills, and understanding through engagement in a culture of inquiry and continuous learning
  • Represent organization at meetings and conferences as applicable

ESSENTIAL RESPONSIBILITIES: Personnel Management 

  • Plan, orient and assign work to personnel that supports goals and objectives contained in the organization’s Strategic Plan
  • Structure and lead operational teams to deliver outstanding team-based services
  • Oversee, direct, and organize the work of support and operational teams and personnel
  • Promote a culture of risk-management, team-based, values-based, high-performance and continually improving practice that values learning and a commitment to quality
  • Establish and monitor assigned staff performance, assign accountabilities, set objectives, and establish priorities
  • Ensure the completion of annual Development Reviews for assigned staff and recommend merit wage adjustments as appropriate, per policy
  • Assist in the recruitment, hiring, orientation, development and evaluation of assigned staff
  • Promote employee retention, productivity, and satisfaction through ongoing support, encouragement, empowerment, coaching and effective teamwork
  • Ensure staff comply with approved organizational policy and procedure
  • Knowledge of federal and state employment and labor laws
  • Assist employees to read, interpret and apply policies and procedures
  • Ensure assigned staff understand and demonstrate the skills necessary to complete their work
  • Support and mobilize assigned staff to engage in their assigned work through implementation of team building, performance coaching and problem-solving strategies
  • Ensure that staff is cross-trained to accomplish the goals and objectives of the organization
  • Responsible to back-up assigned staff caseloads when necessary
  • Respond to the needs of direct and indirect staff with clear, open and honest communication, mutual respect and consistent follow through to generate trust and enhance personal effectiveness
  • Acquire, develop, and retain skilled staff adequate to perform organizational goals and objectives
  • Recommend discharge of employees and volunteers, when indicated, based on work performance and behaviors
  • Demonstrated teaching ability and experience

QUALIFICATIONS

  • Current, unrestricted active Oregon licensure as a Clinical Psychologist, Psychiatric Nurse Practitioners, or Clinical Social Worker (or, if transferring from out-of-state, the ability to secure an Oregon license within 120 days)
  • Masters Degree in related field
  • Non-judgmental attitude
  • Training in Health Literacy, Cultural Awareness, Poverty and Trauma-Informed Care
  • Culturally and Linguistic Appropriate Services (CLAS) Standards

EDUCATION AND EXPERIENCE 

Master’s degree in Social Work, Psychology, Mental Health Counseling, PhD, or other related field. Minimum of five years’ managerial and administrative experience in health care. Three years’ experience in integrated behavioral and physical health care and the delivery of community based services for high risk populations.

KNOWLEDGE

  • A thorough understanding of the theory of the care coordination services to the extent needed to select and apply new techniques or methods
  • Knowledge of managed care settings and experience with integrated health care providers
  • Knowledge of program development and implementation
  • Knowledge of managing a team-based care integrated model
  • Knowledge of utilization and care management
  • Knowledge of Medicaid (Oregon Health Plan) rules and regulations
  • Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
  • Awareness and understanding of equity, diversity and inclusion
  • Awareness of the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices

SKILLS 

  • Skill and ability to monitor systems, processes, and outcomes to identify and effectively address performance improvement opportunities
  • Superior skills in program development, including needs assessment, identifying evidence-based programming that is responsive to identified needs, establishing ambitious and yet attainable and measurable program outcome and impact metrics, program budgeting and cost estimating, developing of logic models, and advanced program evaluation 
  • Demonstrated leadership effectiveness and project management experience
  • Exceptional time management, problem solving, attention to detail, planning, organization, and monitoring skills 
  • Strong data analysis skills 
  • Professional writing and public speaking skills
  • Strong customer service skills 
  • Proficient in Microsoft Word, Excel, Outlook, internet, data entry and 10-key 

ABILITIES 

  • Consistently demonstrates ability to think critically and strategically, manage multiple priorities, and adjust to changing circumstances 
  • Ability to function independently and as a team member 
  • Ability to report to work as scheduled 
  • Ability to handle stress and sensitive situations effectively while projecting a professional attitude 
  • Willingness to work a flexible schedule when circumstances necessitate 
  • Ability to communicate professionally, both orally and in writing 
  • Ability to work with diverse populations 
  • Ability to relate to and interact with people of differing personalities and backgrounds 
  • Sensitive to economic considerations, human needs and aware of how one’s actions may affect others 
  • Ability to organize and work in a sensitive manner with people from other cultures 
  • Poised; maintains composure and sense of purpose 

WORKING CONDITIONS 

  • Physical Demands: Lifting, bending, reaching, pushing, carrying, sitting, vision and hearing corrected in normal range. 
  • Work Condition: 
    • Employee generally works within the interior of an office environment.
    • Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion.
    • Hours of operations and specific staff scheduling may vary between worksite based on operational need. 
    • The general environment is clean with a comfortable temperature and moderate noise level. 
  • Exposed to: Cold/heat controls, close contact with employees and the general public. 
  • Machines, equipment, tools and supplies used: Computer, postage machine, fax, copier, calculator, multi-line telephone system, scanner 
    • May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information 
  • Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task. 

This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of SWOIPA. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

To apply, please visit: www.advancedhealth.com/careers or use the link below: 

https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=d4cc397c-368d-4965-a281-d03c2c6277ef&ccId=19000101_000001&jobId=286128&lang=en_US&source=CC4 

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